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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Dec 10, 2015; 6(6): 237-251
Published online Dec 10, 2015. doi: 10.5306/wjco.v6.i6.237
Therapeutic role of template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract
Tsunenori Kondo, Toshio Takagi, Kazunari Tanabe
Tsunenori Kondo, Toshio Takagi, Kazunari Tanabe, Department of Urology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
Author contributions: Kondo T wrote the paper; Kondo T and Takagi T collected the data; Tanabe K supervised the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tsunenori Kondo, MD, PhD, Department of Urology, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. tkondo@kc.twmu.ac.jp
Telephone: +81-3-33538111 Fax: +81-3-33560293
Received: May 28, 2015
Peer-review started: June 1, 2015
First decision: August 4, 2015
Revised: August 14, 2015
Accepted: October 1, 2015
Article in press: October 8, 2015
Published online: December 10, 2015
Processing time: 195 Days and 17.7 Hours
Abstract

Lymphadenectomy for urothelial carcinoma of the upper urinary tract has attracted the attention of physicians. The mapping study of lymphatic spread has shown that a relatively wide area should comprise the regional nodes for tumors of the right renal pelvis or the right upper two-thirds of the ureter. A prospective study showed that an anatomical template-based lymphadenectomy significantly improved patient survival in tumors of the renal pelvis. This benefit was more evident for patients with pT2 stage tumors or higher. The risk of regional node recurrence is significant reduced by template-based lymphadenectomy, which is likely to be associated with improved patient survival. The removal of lymph node micrometastases is assumed to be the reason for therapeutic benefit following lymphadenectomy. The number of resected lymph nodes can be used to assess the quality of lymphadenectomy, but not to determine the extent of lymphadenectomy. The guidelines currently recommend lymphadenectomy for patients with muscle-invasive disease, even though the current recommendation grades are still low. The present limitation of lymphadenectomy is the lack of standardization of the extent of lymphadenectomy and the randomized trials. Further studies are warranted to collect the evidence to support lymphadenectomy.

Keywords: Lymphadenectomy; Lymph node excision; Urothelial carcinoma; Treatment outcome; Therapeutic uses; Diagnosis; Guideline

Core tip: The role of lymphadenectomy in urothelial carcinoma of the upper urinary tract had examined. A prospective study showed that anatomical template-based lymphadenectomy significantly improves patient survival in tumors of the renal pelvis. This benefit is demonstrated more clearly for patients with pT2 tumors or higher. The risk of regional node recurrence is significant reduced by template-based lymphadenectomy, which is likely to be associated with improved patient survival. The guidelines currently recommend lymphadenectomy for patients with muscle-invasive disease. Further studies are warranted to collect the evidence to support lymphadenectomy.